=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942557665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. ANDREW AUGUSTUS MCGOVERN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2012
-----------------------------------------------------
Last Update Date | 12/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 KENNEDY RD STE 33A
-----------------------------------------------------
City | ANDOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-722-2831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 129
-----------------------------------------------------
City | TRANQUILITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07879-0129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-722-2831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00494600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------